Patients were more likely to be screened for colorectal cancer through fecal immunochemical test (40.7%) and colonoscopy (24.6%) when reached out to by mail versus usual care (12.1%, P<0.001 for both comparisons), according to Samir Gupta, MD, of Veterans Affairs San Diego Healthcare System in California, and colleagues.

More patients responded to requests for fecal immunochemical testing (FIT) than colonoscopy among white, black, and Hispanic patients (P<0.005), they wrote online in JAMA Internal Medicine.

The authors cautioned that although screening for colorectal cancer can save lives, rates of participation are low among minority and uninsured patients. They also questioned whether inviting patients to receive invasive colonoscopy procedures would be more effective at acquiring underserved patients than a less invasive procedure like FIT.

To study whether a mail- and phone-based screening request would boost rates of colorectal screening and if requests for invasive versus noninvasive screening procedures affected participation, the authors mailed invitations for no-cost FIT to 1,593 patients and for no-cost colonoscopy to 479 patients and compared participation with that of "opportunistic primary care visit-based screening" in 3,898 patients.

Participants were ages 54 to 64 and were uninsured, were not up-to-date with colorectal screening, and were a part of a Texas safety net health system. The sample consisted of 41% whites, 24% blacks, 29% Hispanics, and 7% other races.

Patients in the fecal test group were also mailed a one-sample test, which included instructions on how to perform the test, and a postage-paid return envelope for the kit.

Those who received a colonoscopy invitation were also contacted by phone, provided with bowel preps, and received appointment reminders prior to the appointment.

Both interventions had significantly better participation than usual care (P<0.001), and significantly higher percentages of patients followed through on the FIT invitation than colonoscopy (P<0.001).

The authors also reported neoplasia detection rates by screening type. Fecal screening and colonoscopy each found colorectal cancer in 0.4% of those who received the diagnostic treatment, while usual care detected colorectal cancer in 0.2% of participants.

The authors concluded that a mail outreach intervention has "potential to significantly improve screening rates for the underserved and merits implementation."

"For underserved populations, our findings raise the possibility that large-scale public health efforts to boost screening may be more successful if noninvasive tests ... are offered over colonoscopy," they added.

They also noted that the study was limited by a single-invitation measurement of participation that may vary after repeat invitation, lack of meaningful statistical comparisons of neoplasia outcomes, absent data on screening outside of the health system, lack of generalizability, and lack of choice to patients invited through the mailing.

The study was supported by the Cancer Prevention and Research Institute of Texas, the NIH, the National Center for Research Resources, and the NIH/National Cancer Institute.

The authors had no conflicts of interest to disclose.

Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner